October 23, 2023
This Week in Health Policy for October 23
This Week (October 23 - 27)
Senate HELP Committee will hold a field hearing in New Brunswick, NJ on "Overworked and Undervalued: Is the Severe Hospital Staffing Crisis Endangering the Well-Being of Patients and Nurses?"
House Energy & Commerce Health Subcommittee will hold a hearing on "Supporting Access to Long-Term Services and Supports: An Examination of the Impacts of Proposed Regulations on Workforce and Access to Care."
Senate Finance Committee will hold a hearing on "Exploring Paid Leave: Policy, Practice, and Impact on the Workforce."
Senate HELP Committee will hold an executive session on nominations for NIH, EEOC, and more.
Senate Veterans Affairs Committee will hold a hearing on "VA Accountability and Transparency: A Cornerstone of Quality Care and Benefits for Veterans."
House Committee on Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic will hold a hearing on "Reforming the WHO: Ensuring Global Health Security and Accountability."
Last Week (October 16 - 20)
Health Care Highlights
House Republicans unable to rally around a Speaker. On Friday (October 20), the House recessed, concluding the third workweek without a Speaker. Earlier on Friday, Rep. Jim Jordan (R-OH) lost his third ballot for the House Speakership, falling short by 25 votes. Efforts to vote on granting Rep. Patrick McHenry (R-NC) additional powers as acting speaker stalled Thursday (October 19) amid further disagreement within the Republican conference. Without a Speaker, the House can't advance legislation, including any approach to extend funding for the federal government, as well as health care and other programs beyond the November 17 expiration.
ICYMI: Health Care Highlights From October 9-13
CMS publishes 2024 MA, Part D star ratings. Last Friday (October 13), CMS published star ratings for 2024 Medicare Advantage (MA) and prescription drug plans on the Medicare Plan Finder. The data show about 42% of MA plans that offer prescription drug coverage will have a rating of four or more stars in 2024, down from 51% in 2023. Analysts have said the declines can be attributed in part to updates to CMS' methodology and moving further from the COVID-19 pandemic.
CMS increases access to Alzheimer's scan. Last Friday (October 13), CMS issued a decision memo that would allow Medicare Administrative Contractors to make coverage determinations for positron emission tomography (PET) beta amyloid imaging for Alzheimer patients outside of clinical trials.
CMS unveils Part B rates. Last Thursday (October 12), CMS announced 2024 Part B standard premiums would increase about $10 per month compared with 2023 and deductibles would go up about $14. CMS attributed the increases in part to projected increases in health spending and the agency's proposal to repay hospitals participating in the 340B Drug Discount Program $9 billion for past payment cuts as well as broader access to Alzheimer's drugs in Medicare.
CMMI provides status update on prescription drug models. On Wednesday (October 11), the Center for Medicare and Medicaid Innovation published a one-year update on activity related to President Biden's Executive Order 14087, "Lowering Prescription Drug Costs for Americans." In the update, CMMI details actions taken to further develop three models related to prescription drug prices, including conducting targeted analyses to validate the effectiveness and feasibility of the models, gathering input on the models, and identifying important operational and timeline considerations.
Sanders issues report critical of hospitals' tax-exempt status. On Tuesday (October 10), Senate HELP Committee Chair Bernie Sanders (I-VT) released a report examining charitable care provided by nonprofit hospitals and health systems. The report, which is based on hospital's Form 990 Schedule H filings and does not account for the COVID-19 pandemic, concluded that 12 of the 16 nonprofit hospitals reviewed dedicated "less than two percent of their total revenue to charity care" in 2021. The report details policy actions Congress could take to increase oversight of nonprofit hospitals' charity care levels, such as establishing minimum community benefit requirements. The American Hospital Association released a similarly timed analysis of their own, finding that community benefits grew to 15.5% of total hospital expenses in 2020 despite the pandemic.
Hearings, Markups, and Other Committee Action
The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on the Nomination of Monica Bertagnolli to be Director of the National Institutes of Health (NIH). On Wednesday (October 18), the Committee held a hearing to question President Biden's nominee to be Director of the NIH, Monica Bertagnolli. During the hearing, Ms. Bertagnolli committed to ensuring clinical trials are more inclusive and efficient, but avoided answering questions from both Chair Bernie Sanders (I-VT) and Ranking Member Bill Cassidy (R-LA) on reinstating the reasonable pricing clause in NIH contracts, instead committing to working with the Committee on drug prices. The Committee is expected to vote on her nomination on Wednesday (October 25). If approved, her nomination will advance to the full Senate.
House Energy & Commerce Health Subcommittee held a hearing on "Health Legislative Hearing: 'What's the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.'" On Thursday (September 19), the Subcommittee held a hearing on the increasing challenges faced by physicians as a result of Medicare reimbursement cuts. The subcommittee discussed about two dozen bills spanning a range of topics, including Medicare physician reimbursement, electronic prior authorizations, and more. Lawmakers heard testimony from two witness panels. The first included representatives from the Centers for Medicare and Medicaid Services (CMS), the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC), while the second represented physicians, economists, and policy experts.
Senate Budget Committee held a hearing on "Improving Care, Lowering Costs: Achieving Health Care Efficiency." On Wednesday (October 18), the Committee held a hearing during which lawmakers heard from a panel of experts representing academia, physicians and accountable care organizations, and the Congressional Budget Office (CBO). Each expert spoke critically about rising health care costs and offered policy solutions they believed could curtail the growth, such as reducing administrative burdens and spending, accelerating the transition to value-based care, and increasing transparency in health care. Several experts, and lawmakers, spoke about the role of hospital and physician services payments in rising health care costs and ways to address drivers of physician price, such as expanding site-neutral payment reform and increasing antitrust oversight.
Senate Finance Committee held a hearing on "Medicare Advantage Annual Enrollment: Cracking Down on Deceptive Practices and Improving Senior Experiences." On Wednesday (October 18), the Committee held a hearing focused on deceptive marketing practices and the role of third-party marketing organizations. During the hearing, lawmakers heard from a panel of witnesses representing enrollment assisters, MA plan navigation tools, and small MA plans who shared recommendations on ways to improve the MA shopping experience for seniors and crack down on potential bad actors. Members of the Committee shared their concerns and stories of constituents being inundated with MA marketing phone calls and enrolling in plans ill-suited to meet their health needs.
House Energy & Commerce Innovation, Data and Commerce Subcommittee held a hearing on "Safeguarding Data And Innovation: Setting The Foundation For The Use Of Artificial Intelligence." On Wednesday (October 18), the Subcommittee held the first in a series of hearings on AI. During the hearing, Committee Chair Cathy McMorris Rodgers (R-WA) spoke about AI's potential use in health care diagnoses and law enforcement efforts to combat the fentanyl crisis, while Democratic leaders on the Committee and Subcommittee raised concerns about potential HIPAA violations and the potential for AI-related discrimination in health care. Lawmakers from both sides of the aisle appeared to agree a national privacy framework is needed regarding AI.
House Ways and Means Oversight Subcommittee held a hearing on "Investigating Pandemic Fraud: Preventing History from Repeating Itself." On Thursday (October 19), the Subcommittee held a hearing during which lawmakers heard from a panel of witnesses representing risk management and financial consulting firms, the Government Accountability Office, and state labor departments. During the committee, lawmakers spoke about the Internal Revenue Service's recent decision to pause submissions for the Employee Retention Tax Credit due to concerns about fraud and other areas of pandemic-related fraud.
House Committee on Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic held a hearing on "Strengthening Biosafety and Biosecurity Standards: Protecting Against Future Pandemics." On Wednesday (October 18), the Select Subcommittee held a hearing during which lawmakers from both sides of the aisle agreed that they must find bipartisan solutions to biosecurity and pandemic preparedness. During the hearing, there was some consensus among lawmakers around ensuring international laboratories funded by US dollars meet US standards.
Reports, Studies, and Journals
Kaiser Family Foundation: 2023 Employer Health Benefits Survey. The survey, which provides an overview of benefit trends for those enrolled in employer-sponsored health coverage, found annual premiums for employer-sponsored family health coverage reached $23,968 in 2023, with workers contributing an average of $6,575 toward the cost of their coverage.
Government Accountability Office: COVID-19 Relief: States' and Localities' Fiscal Recovery Funds Spending as of March 31, 2023. The report found that most of the COVID-19 relief Congress sent to states and localities was used to replace lost revenue during the pandemic as opposed to public health investments and much of the funding remains unspent.
JAMA: Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees. The study, which examines Medicaid data on 9,414 individuals from 2020, found individuals who started buprenorphine treatment via telemedicine had higher odds of treatment retention but no change in the odds of opioid-related nonfatal overdose.