January 16, 2024
This Week in Health Policy for January 15
This Week (January 15 - 19)
The House and Senate are both in session this week, where appropriators will continue work to work on FY 2024 spending bills before the first CR deadline arrives on January 19th. If lawmakers do not pass applicable appropriations or a new CR a partial government shutdown may occur, and several health care program extenders would expire.
Senate Health, Education, Labor, and Pensions Committee will hold a hearing on "Addressing Long COVID: Advancing Research and Improving Patient Care."
Last Week (January 8 - 12)
Health Care Highlights
Congress returns to busy agenda. Congress returned this week from its winter recess with a new top line spending agreement to fund the remainder of FY 2024 but little progress on advancing actual spending bills or addressing the health care extenders set to expire on January 19th and February 2. The $1.66 trillion FY 2024 topline spending agreement announced by Senate Majority Leader Chuck Schumer (D-NY) and House Speaker Mike Johnson (R-LA) on Sunday would rescind an additional $6.1 billion in funding meant for COVID-19 response (draining what was formerly provider relief fund (PRF) funding) and $10 billion in funding for the Internal Revenue Service (IRS). However, the deal has caused an uproar from some House conservatives, who blocked a procedural vote in opposition to the package, which they say doesn't do enough to secure the border or cut spending. While House Speaker Johnson was originally hoping to pass individual appropriations bills by the two-step deadlines, it is increasingly likely an additional short-term continuing resolution (CR) will be necessary to patch funding beyond January 19. Open questions remain as to how Congress will pass those appropriations and cover the costs of expiring health care extenders, which include funding for community health centers, National Health Service Corps, Teaching Health Center GME, Special Diabetes programs; Medicaid disproportionate share hospital (DSH) payment cut; Medicare Work Geographic Index Floor; WIC nutrition program for women and children; Temporary Assistance for Needy Families (TANF); and certain pandemic preparedness authorities. Provider groups also are urging Congress to retroactively mitigate a 3.4% cut to Medicare physician payments, which took effect on January 1.
HHS reports record exchange plan selection. On Wednesday (January 10), HHS announced a record 20.3 million people have selected a health plan on the Affordable Care Act's exchanges during the 2024 open enrollment period, which launched November 1. HHS said 3.7 million individuals are new to the exchanges and the remainder are returning consumers. President Biden marked the occasion by calling on Congress to make permanent enhanced ACA subsidies.
ARPA-H announces preventive care effort. On Tuesday (January 9), the Advanced Research Projects Agency for Health (ARPA-H) announced the launch of the Health care Rewards to Achieve Improved Outcomes (HEROES) program, which aims to incentivize investment in community-level preventive care services to address preventable health issues in underserved communities. ARPA-H will solicit proposals from "Health Accelerators," which will receive incentive-based awards for quantifiable reductions in specific health outcomes over a three-year period.
HHS launches new resources for Medicaid renewals. On Thursday (January 11), the Department of Health and Human Services (HHS) launched a new online hub of multi-lingual federal resources to help patients and providers with Medicaid and Children's Health Insurance Program renewals or coverage transitions.
Biden admin rescinds Trump-era provider conscience rules. On Thursday (January 11), HHS' Office for Civil Rights published a final rule that partially rescinds a 2019 rule that expanded protections for providers who decline to provide services including abortion for reasons of religion or conscience. The rule restores the former process for enforcing federal conscience laws and takes some new steps to strengthen protections against discrimination related to religion or conscience. Click here for a fact sheet.
FTC settlement bars sharing or selling of sensitive location data. On Tuesday (January 9), the Federal Trade Commission (FTC) announced its first settlement with a data broker that prohibits the sharing or selling of consumers' sensitive location data. The settlement with data broker X-Mode Social and its successor Outlogic settled allegations that the company sold location data that could be used to track a person's sensitive locations such as medical and reproductive health clinics. FTC said these practices violate the FTC Act's prohibition against unfair and deceptive practices.
CMS issues call for health equity proposals. On Monday (January 8), the Centers for Medicare and Medicaid Services (CMS) issued a call for proposals for the CMS Health Equity Conference, which will be held May 29-30. CMS is accepting proposals focused on this year's theme of "Sustaining Health Equity Through Action" through February 9. CMS said proposals should align with the agency's Framework for Health Equity 2022 — 2032 or the CMS Framework for Advancing Health Care in Rural, Tribal and Geographically Isolated Communities.
Senate Democrats inquiry into inhaler prices. On Monday (January 8), Senate HELP Committee Chair Bernie Sanders (I-VT) sent letters to four of the leading manufacturers of inhalers asking about pricing and access to their products. The letters also asked the drugmakers about internal strategies related to patent protections or shifting patients to newer products.
DOL issues final rule on independent contractors. On Monday (January 8), the Department of Labor issued a final rule that raises the threshold for businesses to classify workers as independent contactors, which are used in many sectors, including health care. The final rule, which is set to take effect March 11, rescinds a Trump-era policy and is expected to face legal challenges from businesses.
ICYMI: Health Care Highlights from Winter Recess
FDA grants Florida's drug importation request. On January 5, Florida Governor Ron DeSantis announced that the Food and Drug Administration (FDA) has approved a program allowing the state to import certain prescription drugs from Canada as part of an effort to lower prescription drug costs. The program will be limited to certain drug classes including maintenance medications for chronic conditions such as HIV/AIDS, mental illness, prostate cancer, and urea cycle disorder, and will be restricted to individuals who are under the care of the state's Agency for Persons with Disabilities, Department of Children and Families, Department of Corrections, or Department of Health. Florida plans to expand the program to Medicaid beneficiaries in the future.
Biden admin issues clinical laboratory final rule. On December 28, CMS and the Centers for Disease Control and Prevention (CDC) issued a final rule updating the Clinical Laboratory Improvement Amendments fees and clarifying the CLIA fee regulations. The rule implements a biennial two-part increase of CLIA fees, updates regulations to incorporate technological advancements, and amends provisions governing alternative sanctions, such as civil monetary penalties, directed plan of correction, and onsite state monitoring, to allow such sanctions to be imposed on non-compliant laboratories that operate under Certificates of Waiver.
HRSA updates health professional shortage area lists. On December 29, 2023, the Health Resources and Services Administration (HRSA) released a notice informing the public that it has updated geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSAs) as of December 2, 2023. The lists are available on the shortage area topic page at data.hrsa.gov.
Biden issued new presidential determination on DPA. On December 27, President Joe Biden issued a new presidential determination that gives HHS more authority to use the Defense Production Act (DPA) to increase manufacturing of essential medical projects. The determination waives a DPA requirement to notify Congress of a shortage before taking actions address it.
CMS updates to the federal IDR process. In recent weeks, HHS, Labor, and Treasury (the Departments) made several updates to the federal Independent Dispute Resolution (IDR) process. On December 15, 2023, CMS re-opened the IDR portal for all disputes including single disputes involving air ambulance services, as well as new and previously initiated batched disputes. The Departments also announced several extensions related to the IDR process, which can be accessed here. On December 18, 2023, the Departments issued a final rule, which takes effect January 22, that increases dispute fees to $115 per party per dispute and sets other fees related to the process. On January 12, the Departments updated the No Surprises Act website to reflect the upcoming changes to the certified IDR entity fee ranges.
Supreme Court hears Idaho abortion law case. On January 5, the Supreme Court agreed to hear a case on state abortion bans and the Emergency Medical Treatment and Active Labor Act (EMTALA). The Court also stayed a lower-court injunction that allows Idaho to enforce its law. Oral arguments in the case will take place in April.
Hearings, Markups, and Other Committee Action
House Education and the Workforce Subcommittee on Health, Employment, Labor, and Pensions held a hearing on "Lowering Costs and Increasing Access to Health Care with Employer-Driven Innovation." On Thursday (January 11), the Subcommittee heard from a panel representing an employer, a voluntary employees' beneficiary association (VEBA), an economist, and an academic, on the innovative ways employers are working to reduce health care costs for their workers. Several witnesses spoke about the benefits of direct contracting and the barriers employers, particularly small employers face, in pursuing value-based payment models. Lawmakers and witnesses also spoke about the impact of employer pooling and Association Health Plans (AHPs) on health care costs, with Republicans generally speaking favorably of such plan options and Democrats generally raising concerns about the impact on those outside of pools and raising the need for safeguards and guardrails around such policies.
House Ways and Means Committee held a markup on HR 6918, the "Supporting Pregnant and Parenting Women and Families Act." On Thursday (January 11), the Committee advanced in a party-line vote of 24-18 a bill that would block the Biden administration's proposed rule that targets Temporary Assistance for Needy Families (TANF) funds for pregnancy prevention programming and restricts states from funds to programs that primarily provide pregnancy counseling to women only after they become pregnant.
House Education and the Workforce Committee held a markup of bills related to pregnancy and human trafficking. On Wednesday (January 10), the Committee advanced in a 22-17 vote a bill, the Pregnant Students' Rights Act (H.R. 6914) that would require colleges to accommodate pregnant students. During the markup, several Democrats raised concerns that the bill would limit students' access to abortion services and counseling. The Committee also unanimously passed the Enhancing Detection of Human Trafficking Act (HR 443) targeting human trafficking.
Reports, Studies, and Journals
Annals of Internal Medicine: Acute Hospital Care at Home in the United States: The Early National Experience. The study, which looked at more than 5,100 Acute Hospital Care at Home patients from July 2022 through June 2023, showed mortality rates of 0.5%, skilled nursing facility use rates of 3%, and rehospitalization rates of 6%, with results holding across race and ethnicity.
Bipartisan Policy Center: The Future of Remote Patient Monitoring. The report examines use of remote patient monitoring and makes several policy suggestions for the administration and Congress regarding the appropriate use and coverage of remote monitoring services.
JAMA. Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care. The study found that 23% of patients who were transferred to an intensive care unit or died in a hospital were misdiagnosed or had delayed diagnoses. According to the study, the two most common types of diagnostic errors were assessment problems and appropriate and timely testing.