November 13, 2023
This Week in Health Policy for November 13
This Week (November 13 - 17)
House Committee on Rules will hold a hearing on the Labor, Health and Human Services, Education, and Related Agencies Appropriations Act, 2024
Senate Finance Subcommittee on Health Care will hold a hearing on "Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency."
House Veterans' Affairs Subcommittee on Health will hold an oversight hearing on "Emerging Therapies: Breakthroughs in the Battle Against Suicide?"
Homeland Security and Governmental Affairs Senate Committee Subcommittee on Emerging Threats and Spending Oversight will hold a hearing on "Examining Federal COVID-ERA Spending and Preventing Future Fraud."
House Veterans' Affairs Subcommittee on Technology Modernization will hold an oversight hearing on "Electronic Health Record Modernization Deep Dive: System Uptime"
Last Week (November 6 - 10)
Health Care Highlights
CMS issues MA, Part D proposed rule for contract year 2025. On Monday (November 6), the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes policy changes for Medicare Advantage (MA) and Medicare Part D programs, including many that would take effect for the 2025 plan year. In the rule, CMS proposes new guardrails to limit MA compensation to third-party agents and brokers to $642 and prohibit anti-competitive terms in contracts between MA plans and third-party marketing organizations that could interfere with the agent's or broker's ability to objectively assess and recommend the best plan for a beneficiary. The proposed rule also updates network adequacy standards to include newly eligible behavioral health providers under a Outpatient Behavioral Health category and creates a new exemption from network adequacy time and distance requirements if supplemental telehealth benefits are offered. In addition, the proposed rule adds new enrollee notification requirements and standards regarding supplemental benefits, and requires MA organizations to conduct annual health equity analyses of their prior authorization processes, among other changes. CMS is accepting public comments through January 5, 2024. Click here for the proposed rule. Click here for a fact sheet.
CMS launches 'birthing-friendly' hospital designation. On Wednesday (November 8), CMS launched a new "birthing-friendly" designation on its Care Compare online tool to help patients identify hospitals and health systems that take part in a statewide or national perinatal quality improvement collaborative program and that implement evidence-based maternal health care.
House Ways and Means Republicans concerned about IDR implementation. On Thursday (November 9), House Ways and Means Republicans sent a letter to HHS Secretary Xavier Becerra, Treasury Secretary Janet Yellen, and Acting Labor Secretary Julie Su objecting to the Biden administration's implementation of the No Surprises Act's independent dispute resolution (IDR) process, saying they have not fulfilled congressional intent. The letter comes weeks after the committee held a hearing on the implementation of the law.
Senate confirms new NIH director. On Tuesday (November 7), the Senate voted 62-36 to confirm President Biden's pick, Monica Bertagnolli, as director of the National Institutes of Health (NIH). Ms. Bertagnolli will replace Francis Collins to oversee the NIH, which includes 18,000 employees.
FTC challenges 'Orange Book' listings. On Tuesday (November 7), the Federal Trade Commission (FTC) announced it is challenging more than 100 patents it believes are improperly listed in FDA's "Orange Book." Manufacturers of products challenged will be required to remove their products from the listing or certify that they are in compliance with statutes and regulations.
Hearings, Markups, and Other Committee Action
The Senate Finance Committee held an Open Executive Session to consider "the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act." On Wednesday (November 8), the Committee unanimously advanced the bipartisan Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which aims to expand access to mental health care, address certain pharmacy benefit manager (PBM) practices that affect access to community pharmacies and increase out-of-pocket costs, extend certain Medicare and Medicaid programs set to expire, and shore up Medicare physician payments. While some lawmakers saw their health care priorities added to the chairman's mark prior to the hearing, dozens of other amendments including those on site-neutral payment, graduate medical education, prior authorization and biosimilars were offered and withdrawn, with members and the chair agreeing to continue to evaluate many of the proposals.
Senate HELP Subcommittee on Primary Health and Retirement Security held a hearing on "Avoiding a Cautionary Tale: Policy Considerations for Artificial Intelligence (AI) in Health Care." On Wednesday (November 8), the Subcommittee held a hearing centered on the role and scope of Congress in regulating AI use in health care and the need to strike the right balance between enacting safety guardrails around AI and enabling innovation. During the hearing, lawmakers heard testimony from a panel of witnesses who represented providers, academics, and patients who discussed the potential benefits, harms and use cases of AI in health care. Panelists all agreed that some form of regulatory oversight or AI guardrails are needed but differed on the scope. And while most of the providers spoke about ways AI could be harmful in health care in the future, the witness representing patients said AI is already being used in negative ways and that more human oversight is needed in initial claims decisions specifically.
House Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs held a hearing on pending legislation. On Wednesday (November 8), the Subcommittee held a hearing to discuss legislation related to veterans who are victims of fraud, as well as bills to improve the VA's medical claims and appeals process and more. The Subcommittee heard from three panels, including a panel of lawmakers, a panel representing the Veterans Benefits Administration and Board of Veterans' Appeals, and a panel representing veterans advocates.
Senate Appropriations Committee held a hearing on "A Review of the President's Supplemental Request for the Departments of Health and Human Services and Homeland Security." On Wednesday (November 8), the Committee heard testimony from HHS Secretary Xavier Becerra and Department of Homeland Security Secretary Alejandro Mayorkas on the president's supplemental funding requests.
Reports, Studies, and Journals
HHS Office of Inspector General: General Compliance Program Guidance. The report details information on relevant federal laws, compliance program infrastructure, and OIG resources for health care stakeholder compliance.
Health Affairs: The Health And Social Needs Of Medicaid Beneficiaries In The Postpartum Year: Evidence From A Multistate Survey. A survey of postpartum people conducted in six states and New York City from January 2021 to March 2022 found Medicaid respondents were less likely than those with commercial insurance to have a usual source of care.
Government Accountability Office: Building and Maintaining Infrastructure Beyond the COVID-19 Pandemic. The report examines the Centers for Disease Control and Prevention's preparedness programs to support public health infrastructure in states, localities, and territories and identifies challenges to building and maintaining sufficient infrastructure.