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December 18, 2023

This Week in Health Policy for December 18

This Week (December 18 - 22)

The House and Senate were both slated to leave this week for the holiday recess, but the Senate at least is sticking around in hopes of reaching a bipartisan agreement on border provisions to be added to the national security supplemental, along with Israel and Ukraine funding. The Senate is scheduled to convene at 3:00 p.m. on Monday, December 18 and, at 5:30 p.m. for a confirmation vote.

WCEY's This Week in Health Policy will take a publishing hiatus until Congress reconvenes in the New Year.

Last Week (December 11 - 15)

Health Care Highlights

House passes bipartisan health care bills.

  • On Monday (December 11), the House voted 320-71 to pass the Lower Costs, More Transparency Act (HR 5378), which includes provisions to enhance pharmacy benefit manager (PBM) transparency and reporting to employers, bans PBM spread pricing in Medicaid Managed Care Organization contracts, increases health plan fiduciaries' access to data, codifies price transparency for hospitals and payers, as well as adds price transparency for clinical diagnostic lab tests, imaging, and ambulatory surgical centers, and expands site-neutral payments for certain Medicare-covered drug administration services. The bill also includes provisions to extend funding for Community Health Centers, National Health Services Corps, Teaching Health Center GME programs, and special diabetes programs, as well as delay Medicaid DSH hospital payment cuts.
  • On Monday (December 11), the House passed the Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Reauthorization Act of 2023 (HR 3226), which would reauthorize key research and education programs aimed at preventing preterm births.
  • On Tuesday (December 12), the House voted 386-37 to pass the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, which reauthorizes key programs for patients with substance use disorder and permanently extends Medicaid coverage for medication-assisted treatments.

CMS updates inflation drug rebate program guidance. On Thursday (December 14), CMS released revised guidance providing more information on requirements and procedures for calculating rebates and invoicing manufacturers for Medicare rebates under the Medicare Prescription Drug Inflation Rebate Program. CMS also released a list of 48 Part B drugs and biological products that could see lower beneficiary coinsurance between January 1, 2024 — March 31, 2024. Click here for a fact sheet. Click here for the Part B revised guidance. Click here for the Part D revised guidance. Click here for list of 48 drugs.

ONC unveils interoperability final rule. On Wednesday (December 13), HHS' Office of the National Coordinator for Health IT (ONC) released a final rule updating certification requirements for health information technology developers under its Health IT Certification Program. The final rule establishes new transparency requirements for artificial intelligence and other predictive algorithms used in electronic health records; adopts the United States Core Data for Interoperability Version 3 (USCDI Version 3) as standard for the program effective January 1, 2026; revises certain information blocking definitions and exceptions; and requires participating health IT developers to report interoperability-focused metrics. Click here for a fact sheet. ONC also issued several topic specific fact sheets and measurement spec sheets, which can be accessed here.

CMS unveils new care model for maternal health. On Friday (December 15), The Centers for Medicare and Medicaid Services (CMS) announced the Transforming Maternal Health (TMaH) Model, a new 10-year payment and care-delivery model that will support participating state Medicaid and Children's Health Insurance Program (CHIP) agencies in developing and implementing a whole-person approach to pregnancy, childbirth, and postpartum care. Click here for an FAQ. Click here for model details. Click here for an infographic on the new model.

CMS issues warning letter to PBMs, insurers. On Thursday (December 14), CMS leadership sent a letter to PBMs, Medicare Part D plans, Medicaid managed care plans, and private insurance plans raising concerns about business practices, including prior authorization, that threaten the sustainability of pharmacies and increase administrative burdens on providers.

CMS publishes Medicaid/CHIP scorecard. On Wednesday (December 13), CMS released its 2023 Medicaid and CHIP Scorecard, which is intended to increase transparency about the programs' administration and health care outcomes.

Supreme Court takes up new health cases. On Wednesday (December 13), the Supreme Court announced it will consider a case challenging access to a pill called mifepristone commonly used in medication abortions. However, the court said it will not weigh in on the FDA's original approval of the drug in 2000, but instead will consider changes to the expanded distribution of the drug, including telemedicine prescribing and mail order, which were struck down by a US Court of Appeals. On Monday (December 11), the Court also issued a list of orders directing lower courts to dismiss vaccine mandate cases because the mandates are no longer in place.

CMS provides updates on HCBS spending. On Tuesday (December 12), CMS published a national overview of state home and community-based services (HCBS) spending under the American Rescue Plan, which provided states with a temporary 10 percentage point increase in the FMAP for certain Medicaid expenditures for HCBS from April 1, 2021 and March 31, 2022.

Hearings, Markups, and Other Committee Action

Senate Health, Education, Labor & Pensions Committee held a hearing on "What is Fueling the Diabetes Epidemic?" On Thursday (December 14), the Committee held a hearing during which it heard from a panel of experts, academics, and patient advocates on diabetes. Discussion during the hearing focused on ways to reduce the cost of insulin for diabetes patients, ensure continued funding for special diabetes programs, and address the rising cost of newly approved weight loss drugs.

  • More information available here.

Senate Special Committee on Aging held a hearing on "Understanding a Growing Crisis: Substance Use Trends Among Older Adults." On Thursday (December 14), the Committee heard from a panel of witnesses representing academics, legal experts, and recovery groups and spoke about the ways to address existing gaps in treatment and recovery services for individuals with Medicare or Medicaid.

  • More information available here.

House Energy & Commerce Committee held a hearing on "Leveraging Agency Expertise to Foster American AI Leadership and Innovation." On Wednesday (December 13), the Committee heard from a panel of witnesses representing the Department of Energy (DOE), the Department of Commerce (DOC), and the Department of Health and Human Services' Office of the National Coordinator (ONC) to better understand how the executive branch is approaching artificial intelligence (AI). The hearing focused much of its discussion on how federal agencies will carry out President Biden's Executive Order on Safe, Secure, and Trustworthy AI (EO 14110), with some Republicans raising concerns about the EOs use of the Defense Production Act (DPA) to collect information from AI developers. While the hearing included topics such as national security and energy efficiency, health care was a common thread throughout the discussion with lawmakers from both sides of the aisle, raising questions about AIs use in health care and the impact on the medical profession and patients.

  • More information available here.

Senate Committee on the Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights held a hearing on "The New Invisible Hand? The Impact of Algorithms on Competition and Consumer Rights." On Wednesday (December 13), the Subcommittee held a hearing during which they heard from a panel of experts in AI, civil rights, law, and behavioral science. During the hearing, lawmakers raised concerns about the potential for AI tools to perpetuate bias or discrimination.

  • More information available here.

Senate Health, Education, Labor & Pensions Committee held a markup of health care legislation. On Tuesday (December 12), the Committee advanced three health care bills, including SUPPORT Act reauthorization, SCREENS for Cancer Act of 2023, and Modernizing Opioid Treatment Access Act. The bills would reauthorize key programs to increase access to cancer screenings and respond to the opioid misuse epidemic.

  • More information available here.

Reports, Studies, and Journals

ASPE: Inflation Reduction Act Research Series: Medicare Part B Inflation Rebates in 2023. The HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) report shows 48 Medicare Part B drugs experienced price increases that outpaced the rate of inflation in the last quarter of 2023.

Health Affairs: National Health Care Spending In 2022: Growth Similar To Prepandemic Rates. The Office of the Actuary published the 2022 National Health Expenditures (NHE) estimates, showing total annual US spending on health care increased 4.1% in 2022, with spending growing by 2.2% for hospital care, 2.7% for physician and clinical services, and 8.4% for retail prescription drugs.

American Medical Association. Competition in Health Insurance: A Comprehensive Study of U.S. Markets. The annual report found 73% of U.S. commercial health insurance markets were highly concentrated in 2022.


Contact Information
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Washington Council Ernst & Young
   •  Heather Bell (