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October 2, 2023

This Week in Health Policy for October 2

This Week (Oct. 2 - 6)

If Congress does not reach a deal to avert a government shutdown, lawmakers will continue to work on a short-term package to fund the government. Most other committee activity would be suspended with only one scheduled hearing next week:

Senate Budget Committee will hold a hearing on "The Costs of a Government Shutdown."

  • Date: Thursday, October 5 at 10:00am ET
  • More information available here.

Last Week (Sept. 25 - 29)

Health Care Highlights

Congressional activity on fiscal cliff. Congress continued to take steps toward a continuing resolution (CR) to extend government funding past midnight on Saturday (September 30), but most members said a shutdown of some sort seems inevitable given the lack of consensus in the House.

  • The House on Friday (September 29) failed to pass new a CR proposal that was released overnight. The proposal funds the government through October 31, includes border security provisions, and establishes a 16-member "Fiscal Commission" that must produce legislation and vote on a final report by November 15, 2024. The proposal currently does not include language to avert Medicaid Disproportionate Share Hospital (DSH) reimbursement cuts or extend or address other expiring health care programs.
  • The Senate on Thursday (September 28) cleared another procedural hurdle related to a CR that extends government funding through November 17 and includes provisions to delay the Medicaid DSH cuts and extend authorizations for community health centers, the National Health Service Corps, and Teaching Health Center Graduate Medical Education through November 17. Absent a bipartisan agreement to expedite the process under the Senate rules, the first cloture vote is expected to occur on Saturday (September 30) with final passage on Sunday (October 1).

Both the House and Senate efforts are unlikely to be completed and reconciled by Saturday's midnight deadline to avert a government shutdown.

WCEY will be tracking progress through the weekend and will issue an alert with more implications for the health care industry if a shutdown occurs.

Senate Finance Committee introduces PBM bill. On Thursday (September 28), Senate Finance Committee Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) introduced the bipartisan Modernizing and Ensuring PBM Accountability (MEPA) Act, which would ban PBM compensation in the Medicare program from being tied to drug prices, add new audit and enforcement measures for PBMs, and more. The committee advanced PBM legislation in a 26-1 vote in July.

  • See the attached WCEY Brief - Congressional Proposals to Reform Pharmacy Benefit Manager Practices, for an overview of PBM bills that have been introduced to date.

Democrats probe Medicaid managed care denials. On Thursday (September 28), House Energy and Commerce Committee Ranking Member Frank Pallone (D-NJ) and Senate Finance Committee Chair Ron Wyden (D-OR) sent letters to seven insurers with Medicaid managed care plans seeking information on plans' use of prior authorization, including algorithms and artificial intelligence used to support those decisions. Insurers who received the letters are: Aetna, AmeriHealth Caritas, CareSource, Centene Corp., Elevance, Molina Healthcare, and United Healthcare.

White House publishes workforce development playbook. On Friday (September 29), the White House and the Department of Treasury released a playbook that outlines strategies that state and local governments have implemented using American Rescue Plan funds to invest in workforce development. The featured case studies include training 2,500 new licensed nurses in Oklahoma.

CMS seeks input on OTC preventive services. On Thursday (September 29), the Centers for Medicare and Medicaid Services (CMS) published a request for information seeking public input on ways to ensure coverage and access to preventive services, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies. Interested parties must submit feedback to CMS within the 60-day comment period.

Biden admin to begin enforcing insurer price transparency prescription drug requirements. On Wednesday (September 27), the Departments of Labor, Health and Human Services, and the Treasury issued an FAQ stating their intention to begin enforcing the Transparency in Coverage final rule's prescription drug machine-readable file requirement, which was previously deferred. The Departments said they do not plan to issue future rulemaking on the topic but will issue future guidance with technical requirements and an implementation timeline. The Departments said they will consider enforcement decisions on a case-by-case basis.

SAMHSA awards grants for suicide prevention. On Wednesday (September 27), the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded $232.2 million in grants to help states, territories and tribal organizations build local capacity for the 988 Suicide & Crisis Lifeline and related crisis services.

HHS awards grants to support maternal and perinatal care. On Wednesday (September 27), HHS' Office of Minority Health awarded more than $13 million in grants to 11 organizations, including hospitals, health systems and local health agencies, to develop innovative models to integrate community-based support services into perinatal care. That same day, the Health Resources and Services Administration awarded $90 million in grants to improve maternal health data, services and outcomes and address mental health concerns during and after pregnancy.

ARPA-H unveils research plans and locations. On Tuesday (September 26), the Advanced Research Projects Agency for Health (ARPA-H) announced it will establish regional "hubs" in Dallas, Texas; Cambridge, Massachusetts; and the National Capital Region, as well as a range of "spokes" across the country to accelerate innovation in medicine. On Wednesday (September 27), ARPA-H announced a new project focused on antibiotic-resistant bacteria that will be led by Harvard Medical School and on Thursday (September 28) announced two additional projects one focused on 3D-printing human organs led by Stanford University and another on regenerative tissue and immune system function led by the Cambridge-based Thymmune Therapeutics.

CMS issues 2024 MA and Part D premium data. On Tuesday (September 26), CMS released premium and cost-sharing information for Medicare Advantage (MA) and Part D prescription drug plans for the 2024 calendar year. CMS projects the average monthly premium for all MA plans will rise by 64 cents to $18.50 while the average monthly premium for Medicare Part D coverage will decline by $1.44 to $55.50. CMS said the Inflation Reduction Act will continue to limit monthly cost sharing for insulin products to $35 and reduce costs for adult vaccines. Open enrollment for MA and Part D is scheduled to begin October 15.

CMS announces 2024 Open Payment thresholds. CMS this week announced that the Open Payments reporting thresholds for 2024 is $13.07 for small payments or transfers. CMS said payments should be reported when the total annual value of payments or other transfers to a covered recipient exceeds $130.66 for 2024. The Open Payments database highlights payments and other transfers of value between pharmaceutical and medical device manufacturers and providers.

Hearings, Markups, and Other Committee Action

The House Ways and Means Committee holds a markup of HSA legislation. On Thursday (September 28), the Committee sent to the full House two bills that aim to modernize and increase access to health savings accounts (HSAs). During the markup, Chair Jason Smith (R-MO) and other Republicans on the committee said HSAs needed to be modernized to broaden access and improve their benefits. While some Democrats spoke favorably of provisions in the Bipartisan HSA Improvement Act that would increase access to direct primary care and on-site and near-site employer clinics for HSA enrollees, most Democrats spoke critically of HSAs, saying they serve as tax havens for wealthier Americans. Democrats on the panel criticized the impact the bills would have on the Social Security Trust Fund and for directing money away from the federal government, which could instead be used to increase health care access to low-income Americans.

  • More information available here.

The Senate Budget Committee holds hearing on "Medicare Forever: Protecting Seniors by Making the Wealthy Pay Their Fair Share." On Wednesday (September 27), the Committee held a hearing on the Medicare Trust Fund and ways to extend its solvency. The committee heard from a panel of experts including a former public trustee and a tax professional. While members from both parties showed a willingness to work on a bipartisan plan to extend the Medicare Trust Fund they did not coalesce around a specific plan, with Democrats favoring additional taxes on wealthy Americans and Republicans calling for broader reforms to address health care costs.

  • More information available here.

House Oversight and Accountability Cybersecurity, Information Technology, and Government Innovation Subcommittee and Economic Growth, Energy Policy, and Regulatory Affairs Subcommittee holds joint hearing on "Combating Ransomware Attacks." On Wednesday (September 27), the Subcommittees held a hearing on the growing number of ransomware attacks impacting the US, including the health care system. The Subcommittees heard from a panel of witnesses including cybersecurity expert and representatives from education and health systems.

  • More information available here.

Senate Finance Committee holds hearing on federal nominations. On Thursday (September 28), the Committee held a hearing to consider nominations for several positions, including two nominations to serve on the board of the Federal Supplementary Medical Insurance Trust Fund: Tricia Neuman of the Kaiser Family Foundation and Demetrios Kouzoukas, former CMS Medicare director under the Trump administration.

  • More information available here.

Reports, Studies, and Journals

Congressional Budget Office: Federal Budgetary Effects of the Activities of the Center for Medicare & Medicaid Innovation. The report found the Center for Medicare and Medicaid Innovation increased direct spending by more than $5 billion in its first decade, despite initial estimates that it would save $2.8 billion during that time and is now expected to increase net federal spending by $1.3 billion from 2021—2030.

JAMA: Suicide Risks of Health Care Workers in the US. The study, which examined pre-COVID-19 pandemic data from 2008 through 2019, found an increased risk of suicide for health care workers compared with non-health care workers including specifically for registered nurses, health care support workers, and health technicians.

Health Affairs: Choosing Or Losing In Behavioral Health: A Study Of Patients' Experiences Selecting Telehealth Versus In-Person Care. The study found that a patient's perceived lack of choice between in-person and virtual care affected their level of satisfaction and rapport with clinicians and motivated some to seek care elsewhere.


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


PBM bills overview