June 10, 2024 This Week in Health Policy for June 10 This Week (June 10 - 14) House Energy and Commerce will hold a hearing on "Checking-In on CMMI: Assessing the Transition to Value-Based Care."
Senate Finance Committee will hold a hearing on "Youth Residential Treatment Facilities: Examining Failures and Evaluating Solutions."
Senate Committee on Commerce, Science, & Transportation will hold a markup of legislation on spectrum auction
House Committee on Education and the Workforce is expected to hold a markup of legislation related to workers compensation
House Rule Committee is expected to review proposed amendments of the National Defense Authorization Act, including the BIOSECURE Act
Last Week (June 3 - 7) Health Care Highlights House passes VA FY 2025 spending bill. On Wednesday (June 5), the House voted 209-197 to pass the Department of Veterans Affairs (VA) and military construction projects FY 2025 appropriations bill. The bill includes provisions to prevent the VA from implementing rules that would expand access to abortion, restrict veterans' access to gender-affirming care and bar the VA from processing medical claims for undocumented people. The bill also includes an amendment that would lift a directive preventing VA medical staff from recommending veterans participate in states' medical marijuana programs. The bill marks the first of 12 FY 2025 appropriations bills the House and Senate will need to pass by September 30. HHS announces new ACA navigator funding. On Friday (June 7), the Department of Health and Human Services (HHS) announced it will invest an additional $500 million in navigators who are tasked with helping people enroll in coverage through the Affordable Care Act's (ACA) exchanges. The announcement was part of HHS issuing new reports on coverage gains among minority communities. HHS adds 10 new states to Certified Community Behavioral Health Clinic (CCBHC) model. On Tuesday (June 4), HHS announced 10 new states will join the CCBHC Medicaid Demonstration Program, which provides states with funding to help expand access to mental health and substance use services. The new states — Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island and Vermont — join eight other states already operating in the model. The Bipartisan Safer Communities Act authorized HHS to expand the model to 10 additional states every two years. Judge rules against CMS in MA star ratings case. On Monday (June 3), a federal judge ruled in favor of a health plan challenging how the Centers for Medicare and Medicaid Services (CMS) calculated their Medicare Advantage (MA) star rating, which declined from 4.5 to 3.5. The judge ordered CMS to pay $250 million, ruling that CMS violated the Administrative Procedure Act when it modified how star ratings are calculated. CMS has not stated if it will appeal the ruling, however three other insurers have also filed similar lawsuits and may open reconsideration of other ratings. ICYMI: Health Care Highlights From the Memorial Day Recess May 27-31 CMS hosts Health Equity Conference. On May 29-30, CMS hosted its Health Equity Conference highlighting agency and private sector efforts to improve health equity. Sessions during the conference focused on several topics including maternal health equity, reducing care access disparities, data collection and appropriate health equity measures, value-based care, and more. HHS clarifies breach notification requirements for hospitals impacted by Change Healthcare cyberattack. On May 31, HHS' Office for Civil Rights (OCR) announced that hospitals can require UnitedHealth Group to notify patients if their data was stolen during the February 22 cyberattack on Change Healthcare. In an FAQ, OCR wrote, " … if covered entities affected by this breach ensure that Change Healthcare performs the required breach notifications in a manner consistent with the HITECH Act and HIPAA Breach Notification Rule, those covered entities would not have additional HIPAA breach notification obligations." CMS opens applications for ACO Primary Care Flex Model. On May 30, CMS issued a request for applications for the Accountable Care Organizations Primary Care Flex Model (ACO PC Flex) a voluntary model aimed at improving primary care delivery in the Medicare Shared Savings Program. Applications will remain open until August 1. CMS on May 30 also issued a request for applications for the second cohort of participants in the Enhancing Oncology Model (EOM). CMS said the EOM portal would be open from July 1 to September 16. Hearings, Markups, and Other Committee Activity House Energy & Commerce Oversight and Investigations Subcommittee held a hearing on "Oversight of 340B Drug Pricing Program." On Tuesday (June 4), the Subcommittee held a hearing on the 340B Drug Pricing Program during which members heard from a panel of witnesses representing a county-run safety-net hospital, community health centers, disproportionate share hospitals (DSH), and policy analysts. During the hearing, there was broad bipartisan support for the 340B program, as well as bipartisan agreement that legislative changes could improve the integrity of the program. Some of the most discussed policies included increasing transparency around 340B dollars, clarifying the definition of a 340B patient, giving patients the flexibility to choose where they receive discounted drugs, tightening covered entity eligibility, and increasing the Health Resources and Services Administration's (HRSA) ability to oversee the program.
Senate Health, Education, Labor & Pensions Committee held a hearing on "The Assault on Women's Freedoms: How Abortion Bans Have Created a Health Care Nightmare Across America." On Tuesday (June 4), the Committee held a hearing during which members discussed access to abortion care following the Supreme Court's June 2022 ruling overturning Roe v Wade. During the hearing, members heard from a panel of witnesses representing reproductive health providers, patients, and reproductive health policy analysts.
House Ways and Means Work and Welfare Subcommittee held a hearing on "Reforming Unemployment Insurance to Support American Workers and Businesses." On Tuesday (June 4), the Subcommittee held a hearing during which members discussed reforms to the unemployment insurance program. The Subcommittee heard from a panel of witnesses representing fraud experts, academics, policy analysts, and workforce development experts.
House Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic held a "Hearing with Dr. Anthony Fauci." On Monday (June 3), the Select Subcommittee heard testimony from the former National Institute of Allergy and Infectious Diseases Director Anthony Fauci. During the hearing, Fauci fielded questions on COVID-19, the origins of the SARS-CoV-2 virus, and US response to the global pandemic.
Special Committee on Aging and Veterans' Affairs Committee held a hearing on "Heroes at Home: Improving Services for Veterans and their Caregivers." On Wednesday (June 5), the Special Committee held a hearing to discuss ways to better support veterans' in-home care. Most of the discussion focused on ways to better support veteran caregivers. Reports, Studies, and Journals Health Affairs: Advancing Health Equity Through Value-Based Care: CMS Innovation Center Update. The study provides an update on the CMS Innovation Center's strategic goal of incorporating health equity into models, showing an increase in safety-net provider participation in models, and plans to continue integrating health equity into more permanent Medicare and Medicaid payment policy. Congressional Budget Office: CBO's Outlook for U.S. Fertility Rates: 2024 to 2054. The report projects total fertility rates will remain largely flat through 2054 with some variance by age demographic. Government Accountability Office: Medicaid: Managed Care Plans' Prior Authorization Decisions for Children Need Additional Oversight. The report found some states failed to monitor Medicaid managed care plans' use of prior authorization (PA) for children's health care services and recommended CMS communicate expectations for how states should monitor plans' PA decisions and confirm that states meet those expectations.
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