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January 29, 2024

This Week in Health Policy for January 29

This Week (January 29 - February 2)

This week, while negotiators continue discussions around federal funding for the remainder of FY 2024, the House could vote on Tax Relief for American Families and Workers Act (H.R. 7024), which includes provisions related to TCJA pre-cliffs, the Child Tax Credit (CTC), extending a tax deduction for domestic research and development, and more.

House Energy & Commerce Subcommittee on Health hearing titled "Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers."

  • Date: Wednesday, January 31 at 10AM ET
  • More information available here.

Senate Health, Education, Labor & Pensions Committee will hold a hearing titled " Authorization for Investigation into the High Costs of Prescription Drugs and Related Subpoenas."

  • Date: Wednesday, January 31 at 11AM ET
  • More information available here.

Senate Committee on Veterans' Affairs will hold a hearing on "Vet Centers: Supporting the Mental Health Needs of Servicemembers, Veterans and their Families."

  • Date: Wednesday, January 31 at 3:30PM ET
  • More information available here.

House Committee on Oversight and Accountability will hold a hearing on "Overseeing the Department of Health and Human Services' Compliance with Congress."

  • Date: Wednesday, January 31 at 3:30PM ET
  • Witness: Melanie Egorin, Assistant Secretary for Legislation, HHS
  • More information available here.

Last Week (January 22 - 26)

Health Care Highlights

Senate Finance Committee unveils framework to address drug shortages. On Thursday (January 25), the Senate Finance Committee released a white paper that outlines policies the committee is considering as it works on bipartisan legislation to address generic drug shortages. The proposals include Medicare payment reforms for generic sterile injectables, such as financial incentives for hospitals to purchase from quality manufacturers; policies to prevent and mitigate hospital drug shortages; and modifications to the Medicaid drug rebate program and the Medicare Part D program.

Lawmakers urge CMS to crack down on MA overpayments. On Friday (January 26), Sen. Elizabeth Warren (D-MA) and Rep. Pramila Jayapal (D-WA) sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, outlining actions the agency should take to reduce overpayments to Medicare Advantage insurers and improve the quality bonus process, including increasing the coding intensity and adjustment factor and raising the standard for quality bonus payments.

CMS seeks information on Medicare Advantage. On Thursday (January 25), CMS published a request for information (RFI) seeking input on the types of data collected, as well as data that should be collected, related to the Medicare Advantage (MA) program. The RFI covers a wide-range of data topics, including provider directories and networks, prior authorization and utilization management, cost and utilization of different supplemental benefits, MA marketing and consumer decision-making, care and quality outcomes, prescription drug plans, competition and more. The RFI will remain open for 120 days.

FTC sues to block North Carolina hospital acquisition. On Thursday (January 25), the Federal Trade Commission (FTC) sued to block Novant Health's $320 million proposed acquisition of two North Carolina hospitals from Community Health Systems. FTC in the complaint cited Novant's large presence in the market and said the health system is "one of the most expensive" in the state.

HRSA kicks off new National Maternal Health Initiative. On Thursday (January 25), the Health Resources & Services Administration (HRSA) launched a year-long Enhancing Maternal Health Initiative that aims to strengthen, expand, and accelerate HRSA's maternal health work to address maternal mortality and maternal health disparities.

Senators ask for update on FTC's probe into PBMs. A bipartisan group of senators led by Sens. Chuck Grassley (R-IA) and Maria Cantwell (D-WA) sent a letter to the FTC seeking an update on their inquiry into pharmacy benefit managers' business practices. The senators asked the FTC to complete its study in "a timely manner" and to publish a progress report on the investigation's status.

Senate Finance Committee Chairman sends letters to MA third-party marketing companies. On Tuesday (January 23), Chairman Ron Wyden (D-OR) sent letters to five third-party marketing organizations that participate in MA enrollment asking them to provide information by January 31 about their business practices. The request, which went to eHealth, GoHealth, Agent Pipeline, SelectQuote, and TRANZACT seeks information on how the organizations use insurance agents, is the latest action from the committee which has been exploring problematic MA marketing practices.

House Education & the Workforce Committee issues RFI on ERISA. On Monday (January 22), the Committee published an open letter to the employer community noting the 50th anniversary of the Employer Insurance Retirement Security Act (ERISA) and asking for feedback on issues related to transparency, portability, data sharing, quality metrics and more. Specifically, the letter asks employers to share challenges related to offering high-cost specialty drugs and ways to strengthen the Health Insurance Portability and Accountability Act's privacy protections.

Senators urge Biden to reject IP easing for COVID-related products. On Thursday (January 25), a bipartisan group of senators led by Senate Finance Committee Ranking Member Mike Crapo (R-ID) sent a letter to President Biden urging him to block a World Trade Organization proposal that would ease intellectual property protections to help facilitate generic production of COVID-19 treatment drugs and testing materials.

HHS unveils voluntary cybersecurity goals for hospitals. On Wednesday (January 24), the Department of Health and Human Services (HHS) unveiled a set of voluntary cybersecurity performance goals to help health care facilities prevent potentially harmful cyberattacks. The goals are divided into two categories: essential goals to help facilities address common vulnerabilities and enhanced goals to help facilities protect against more sophisticated attacks. The announcement comes after HHS last month said CMS plans to propose mandatory cybersecurity requirements for hospitals. The American Hospital Association said while it supports the voluntary measures it does not support mandatory cybersecurity requirements.

CMS shares final signup figures for marketplace 2024 open enrollment period. On Wednesday (January 24), CMS announced that 21.3 million consumers signed up for a 2024 individual market health insurance plan through the Affordable Care Act exchanges during the latest open enrollment period. According to CMS data, about 2.4 million, or 15%, of people who signed up through had previously been on Medicaid/Children's Health Insurance Program (CHIP). These figures only capture those who selected a plan, not those who have paid their first month's premium, cementing their enrollment. Special enrollment periods remain in place for those no longer eligible for Medicaid/CHIP, as well as for individuals with household incomes less than 150% of the federal poverty level.

CMS announces new grant opportunity for school-based health services. On Wednesday (January 24), CMS announced it will provide 20 states up to $2.5 million each in grant funding to help states implement, enhance or expand school-based health services through Medicaid and the CHIP. Grant applications will be due by March 25, 2024, with funding anticipated by this summer.

FDA accepts AI/ML behavioral health tool into ISTAND. On Tuesday (January 23), the FDA's Center for Drug Evaluation and Research (CDER) and Center for Biologics Evaluation and Research (CBER) announced it recently accepted a new submission for an automated depression and anxiety severity measurement tool into the Innovative Science and Technology Approaches for New Drugs (ISTAND) Pilot Program. The submission marks the first artificial intelligence/machine learning-based and digital health technology-based project to accepted into ISTAND.

White House announces new actions related to reproductive health. On Monday (January 22), the White House announced several actions regarding reproductive care, marking what would have been the 51st anniversary of Roe v. Wade:

  • New guidance clarifying standards and support for expanded coverage of FDA-approved contraceptives
  • A letter from HHS Secretary Xavier Becerra reinforcing payers' coverage obligations for contraceptives
  • New resources to educate providers and patients about their rights to emergency medical care under the Emergency Medical Treatment and Labor Act (EMTALA). As part of the effort, CMS will partner with hospital and provider associations to share training materials on providers' obligations under EMTALA and convene providers to discuss best practices and challenges related to EMTALA.

Hearings, Markups

Senate Aging Committee held a hearing on "Assisted Living Facilities: Understanding Long-Term Care Options for Older Adults." On Thursday (January 25), the committee held a hearing to examine the state of assisted living in the United States. During the hearing, lawmakers heard from a panel of experts representing patients, academics, and both for-profit and not-for-profit assisted living providers. The discussion focused on the quality and cost of assisted living care and the challenges patients and providers face.

  • More information available here.

Reports, Studies, and Journals

Government Accountability Office: Hospital Financing: Volume Limits and Reporting Could Help Manage Risks of Expanding FHA's Mortgage Insurance Program. The report details recommendations for Congress to consider amid conversations to expand the Federal Housing Administration's Hospital Mortgage Insurance Program, which insures loans for capital improvements at hospitals that primarily provide general acute care services.

CMS: Comprehensive Primary Care Plus (CPC+) Final Evaluation Report. The report, which was conducted by Mathematica, found that while the CPC+ model reduced emergency department (ED) visits, acute inpatient hospitalizations, and acute inpatient expenditures, it did not reduce total Medicare expenditures or achieve net savings. The report also did not find systematic differences in primary outcomes between Track 1 and Track 2 practices despite greater resources for Track 2 practices.

MedPAC/MACPAC: Beneficiaries Dually Eligible for Medicare and Medicaid. The latest report provides an update on the dual-eligible population's composition, service use, and spending in calendar year 2021, as well as overlap in Medicaid and Medicare managed care enrollment.

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Contact Information

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Washington Council Ernst & Young