November 20, 2023
This Week in Health Policy for November 20
This Week (November 20 - 24)
The House and Senate are in recess this week and are scheduled to reconvene the week of November 27.
Last Week (November 13-17)
Health Care Highlights
Congress temporarily extends government funding with some health extenders. On Thursday (November 16), President Biden signed into a law a temporary spending bill to extend government funding beyond November 17. The two-step continuing resolution (CR) put forward by Speaker Mike Johnson (R-LA) funds the Military Construction-Veterans Affair; Agriculture, which includes the Food and Drug Administration (FDA); Transportation-HUD; and Energy & Water appropriations bills through January 19 and the remainder of appropriations, including those for the Health and Human Services (HHS) Department, through February 2. The House on November 14 passed the Further Continuing Appropriations and Other Extensions Act, 2024 (H.R. 6363) in a 336-95 vote and on November 15 the Senate voted 87-11 to pass the bill. The bill includes some temporary health care extenders authorizing funding for certain pandemic preparedness services, community health centers, the National Health Service Corps and Teaching Health Center Graduate Medical Education until January 19. The bill also delays Medicaid Disproportionate Share Hospital cuts through January 19, delays for one year the 2024 cuts to the Clinical Laboratory Fee Schedule and extends the physician payment work Geographic Practice Cost Indices floor for 2024. However, the bill leaves out several other health care program extenders.
The focus is now on how and whether a longer-term deal on spending can be reached before the January-February deadlines. The House has approved seven of the 12 annual appropriations bills on a partisan basis. Generally, conservatives have called for spending to be reduced to FY2022 levels, and that is reflected in House appropriations bills along with controversial policy riders. Senators of both parties support holding FY2024 appropriations bills to FY2023 spending levels, as the debt limit bill prescribed, and the Senate has passed three of the dozen spending bills on a bipartisan basis, as a single minibus. One motivating factor to find a bipartisan deal on full-year spending bills is the Fiscal Responsibility Act (FRA) provision that will impose temporary caps at 99% of current funding levels (FY2023) if all 12 appropriations bills are not passed by January 1 of either 2024 or 2025, respectively (with the technical sequester enforcement mechanism related to the funding reduction taking effect on April 30).
With the government now funded through early next year, prospects for a year-end package are in question. If a year-end package does not materialize, lawmakers in January could try to put together a health care package that could include bipartisan and bicameral proposals that have advanced out of committee, such as pharmacy benefit manager legislation, program extensions and provider policies including mitigating the 3.4% cut to the Medicare Physician Fee Schedule conversion factor set to take effect on January 1.
CMS publishes final rule on nursing home ownership transparency. On Wednesday (November 15), the Centers for Medicare & Medicaid Services (CMS) published a final rule that requires Medicare skilled nursing facilities and Medicaid nursing facilities to disclose certain ownership, managerial, and other information. The rule is part of an effort to increase transparency into places where private equity is involved in health care. Click here for a fact sheet. Click here for a press release.
CMS issues proposed Notice of Benefit and Payment Parameters for 2025. On Wednesday (November 15), CMS issued the 2025 Notice of Benefit and Payment Parameters proposed rule, detailing proposed standards for qualified health plans offered through the health insurance marketplaces for 2025. The rule proposes new network adequacy standards for qualified health plans, including time and distance standards, and policies to simplify the plan selection process and improve access to dental benefits and prescription drugs. Click here for a fact sheet.
Long-time FDA leader to retire. On Thursday (November 16), Principal Deputy FDA Commissioner Janet Woodcock confirmed her plans to retire early next year from the FDA. Woodcock, who joined FDA in 1986 at its biologics center, has held several positions within the agency including serving as principal deputy commissioner.
White House, HHS release new resources to coordinate health care and social services. On Friday (November 17), the White House and CMS’ Office of Minority Health released new resources to help support federal agencies, states, local and tribal governments to better coordinate health care, public health, and social services. The resources include the U.S. Playbook to Address Social Determinants of Health, as well as a Call to Action to Address Health Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework.
CMS awards new round of Medicare-funded GME slots. On Wednesday (November 15), CMS announced 200 new graduate medical education (GME) residency slots awarded to 99 qualifying hospitals to support hospitals serving underserved communities. This marks the second round of the 1,000 new Medicare-funded medical residency positions authorized under the Consolidated Appropriations Act (CAA), 2021.
HHS launches long COVID advisory committee. On Thursday (November 16), HHS announced it will launch an advisory committee to help guide the government in equitably responding to the long-term impacts of COVID-19.
FDA restructures Office of Pharmaceutical Quality. FDA has shared plans to reorganize the Center for Drug Evaluation and Research’s (CDER) Office of Pharmaceutical Quality as part of a broader effort to address drug shortages. Effective January 14, 2024, the Office of New Drug Products, Office of Lifecycle Drug Products, and Office of Biotechnology Products will reside under the Offices of Pharmaceutical Quality Assessment while research will be consolidated under a new Office of Pharmaceutical Quality Research. Quality assessment activities will be overseen by the Deputy Director of Science, and a new Office of Quality Assurance will oversee training and development and other activities.
40 states extend Medicaid postpartum coverage. On Tuesday (November 14), CMS approved Missouri’s state plan amendment allowing the state Medicaid program to extend postpartum coverage to a full year. The approval makes Missouri the 40th state to expand their postpartum coverage under the flexibilities made under the American Rescue Plan and the Consolidated Appropriations Act, 2023.
White House launches effort to accelerate women’s health research. On Monday (November 13), First Lady Dr. Jill Biden launched a new initiative to support women’s health research, calling on federal agencies, including HHS, NIH, the Department of Defense, and the Department of Veterans Affairs to recommend ways to accelerate women’s health research and close treatment gaps for women.
Hearings, Markups, and Other Committee Action
House Energy and Commerce Health Subcommittee held a markup of 21 legislative proposals. On Wednesday (November 15), the House Energy and Commerce Health Subcommittee advanced 21 bills to the full committee. The bills advanced cover a range of topics, including baring certain pharmacy benefit manager (PBM) practices and increasing transparency, accelerating Medicare beneficiaries’ access to new treatments and services, limiting Part D beneficiaries’ out-of-pocket costs, addressing Medicare physician pay and expiring incentive payments and more. While 13 of the bills advanced were bipartisan, Democrats, including Committee Chair Frank Pallone (D-NJ) raised concerns with some of the proposals and their impact on Medicare beneficiaries’ out-of-pocket costs and federal spending. At the start of the hearing, Subcommittee Chair Brett Guthrie (R-KY) said they are working to identify bipartisan offsets to ensure all of the bills are fully offset when considered by the full committee.
Senate Finance Subcommittee on Health Care held a hearing on “Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency.” On Tuesday (November 14), the Subcommittee held a hearing that was marked by its bipartisan tone, with both Republicans and Democrats speaking about the importance of enabling telehealth services and the need to identify which Medicare telehealth waivers should be made permanent. Subcommittee leaders and members spoke about the need to address the waivers well in advance of their 2024 expiration date to ensure providers have the foresight to adjust their strategic planning. During the hearing, lawmakers heard from a panel of witnesses representing telehealth education centers, providers, and academics. The witnesses agreed telehealth waivers eliminating restrictions on geographic locations and sites of care should be lifted, but one witness raised concerns about continuing payment parity for telehealth services and permanently allowing audio-only services – concerns the other witnesses rejected.
Senate Veterans’ Affairs Committee held a hearing on “VA’s Fourth Mission: Supporting Our Nation’s Emergency Preparedness and Response.” On Wednesday (November 15), the Senate held a hearing on the VA’s role in national emergency preparedness and response, including discussion on the US supply chain and reliance on foreign countries. During the hearing, lawmakers heard from a panel of witnesses representing the Department of Veterans Affairs’ Office of Emergency Management and Resiliency, the Veterans’ Health Administration, and HHS. Lawmakers
House Veterans’ Affairs Subcommittee on Health held an oversight hearing on “Emerging Therapies: Breakthroughs in the Battle Against Suicide?” On Tuesday (November 14), the Subcommittee held a hearing on new therapies and innovations to combat suicide among veterans. The Subcommittee heard from two panels representing Department of Veterans Affairs, behavioral health experts, and veteran advocates.
Homeland Security and Governmental Affairs Senate Committee Subcommittee on Emerging Threats and Spending Oversight held a hearing on “Examining Federal COVID-ERA Spending and Preventing Future Fraud.” On Tuesday (November 14), the Subcommittee held a hearing that examined fraud related to the COVID-19 pandemic and ways to mitigate such issues going forward. The Subcommittee heard from a panel of witnesses representing Department of Justice’s Inspector General, the U.S. Small Business Administration’s Inspector General; the Department of the Treasury; and the Government Accountability Office.
House Veterans’ Affairs Subcommittee on Technology Modernization held an oversight hearing on “Electronic Health Record Modernization Deep Dive: System Uptime.” On Wednesday (November 15), the Subcommittee held a hearing during which lawmakers expressed frustration with the VA’s electronic health record system transition and underreporting of system performance issues. The lawmakers heard from a panel of witnesses representing the Department of Veterans Affairs and the Department of Defense, as well as written testimony from Oracle, which oversees the VA’s EHR contract.
Reports, Studies, and Journals
JAMA: Initial Findings From an Acute Hospital Care at Home Waiver Initiative. The research letter reports on key steps CMS has taken to ensure patient safety for patients receiving care in the home setting during the initial 16 months of the Acute Hospital Care at Home (AHCAH) initiative and finds patients who participated in the program had a low mortality rate and minimal complications related to escalations back to the brick-and-mortar hospital.
HHS: Department of Health and Human Services Agency Fiscal Year 2023 Financial Report. The report explores improper payment data and corrective actions related to the payment of the Advance Premium Tax Credit, Medicare Fee-for-Service, Medicare Advantage, Medicare Part, and Medicaid/Children's Health Insurance Program (CHIP) programs.
Congressional Research Service: The FRA’s Discretionary Spending Caps Under a CR: FAQs. The report details how the latest continuing resolution will impact discretional spending caps set forth in the Fiscal Responsibility Act and how the law’s spending limits compare to FY 2023 spending.