THIS WEEK’S DOSE
House Republicans attended their annual retreat in Orlando, after which the House returned to session mid-week. FY 2024 budget hearings dominated committee agendas in both the House and Senate. President Biden signed a bill declassifying government information on the origins of COVID-19.
FY 2024 Budget Hearings Continue. With budget season in full swing, Biden Administration officials continued to make the rounds on Capitol Hill this week to defend the president’s FY 2024 budget request.
On March 22, US Department of Health and Human Services (HHS) Secretary Xavier Becerra testified at a Senate Finance Committee hearing. Secretary Becerra provided details on HHS’s funding priorities, including increasing access to equitable healthcare, tackling the mental and behavioral health crisis, lowering the cost of prescription drugs and strengthening the Medicare program.
The Secretary fielded a myriad of questions from committee members on issues such as proposed payment changes to Medicare Advantage, protecting Medicare benefits, the importance of behavioral health crisis care coordination, the impacts of the new Medicare prescription drug price negotiation program, Medicare coverage for Alzheimer’s disease treatments, strengthening organ transplantation accountability and transparency, and the importance of extending telehealth flexibilities.
Secretary Becerra also testified before the Senate Appropriations Labor-HHS Subcommittee on March 22. The partisan divide and lines of questioning were similar to those of the Finance Committee hearing.
Secretary Becerra is scheduled to appear before the House Ways and Means Committee on March 28, and the House Energy and Commerce Committee on March 29.
House Energy and Commerce Committee Advances Five Healthcare Bills. On March 23 and 24, the full Energy and Commerce Committee met to consider and advance 19 bills, five of which are health related and were previously advanced by the Health Subcommittee:
- The Block, Report, And Suspend Suspicious Shipments Act (H.R. 501) would require drug manufacturers, distributors and other US Drug Enforcement Administration registrants to practice due diligence when discovering suspicious orders of controlled substances.
- Advanced by a unanimous vote
- The 9-8-8 Lifeline Cybersecurity Responsibility Act (H.R. 498) would require internal coordination within HHS to protect the 9-8-8 lifeline from cybersecurity incidents and would require the 9-8-8 network administrator to immediately report potential cybersecurity threats.
- Advanced by a unanimous vote
- The Protecting Health Care for All Patients Act (H.R. 485) would prohibit all federal healthcare programs, including the Federal Employees Health Benefits Program, and federally funded state healthcare programs such as Medicaid from using prices that are based on quality-adjusted life years to determine relevant thresholds for coverage, reimbursements or incentive programs.
- Advanced by a party-line vote of 27-20, with one member, Rep. Anna Eshoo (D-CA) voting “present”, after a substitute amendment by Ranking Member Frank Pallone (D-NJ) that would have ensured that nothing in the bill could be used to delay or disrupt the implementation of the drug price negotiations in the Inflation Reduction Act failed along a party line vote
- The HALT Fentanyl Act (H.R. 467) would place fentanyl-related substances permanently into Schedule I of the Controlled Substances Act.
- Advanced by a largely party line vote of 27-19
- The Securing the Border for Public Health Act (H.R. 801) would allow the HHS Secretary, after consultation with the attorney general, to suspend persons and imports related to certain controlled substances from certain designated foreign countries into the United States.
- Advanced by a party line vote of 24-19.
The bills now await consideration on the House floor.
Senate Commerce Committee Advances PBM Bill. On March 22, the Senate Commerce Committee held an executive session, during which it advanced the Pharmacy Benefit Manager (PBM) Transparency Act (S. 127) by a vote of 18–9. The bipartisan bill, which is sponsored by Commerce Committee Chair Maria Cantwell (D-WA) and Senator Chuck Grassley (R-IA), aims to increase transparency and prevent unfair PBM practices, including spread pricing, when a PBM charges an insurance plan more than it reimburses a pharmacy for a drug.
The bill now awaits consideration on the Senate floor.
CBO Reports It Overestimated Medicare and Medicaid Spending. On March 17, the nonpartisan Congressional Budget Office (CBO) released a report highlighting that it overestimated mandatory spending for healthcare in its 2010–2020 projections.
CBO reported that over that period, mandatory outlays for the two broad budget categories covering the major healthcare programs (mostly Medicare and Medicaid) were 9% lower than projected in 2010. According to CBO, most of the overestimate stemmed from an overestimate of spending per beneficiary, not an overestimate of the number of beneficiaries. Less-than-anticipated spending for prescription drugs in Medicare Part D and for long-term services and supports in Medicaid were two significant sources of error in CBO’s 2010 projections.
This update from CBO comes as Congress hears from the Administration on its budget request and begins to debate FY 2024 spending levels, in addition to upcoming debt ceiling negotiations.
No Surprises Act Update. On March 17, the Centers for Medicare & Medicaid Services (CMS) announced that under the No Surprises Act, certified independent dispute resolution (IDR) entities will resume issuing payment determinations for disputes involving items or services furnished on or after October 25, 2022.
In late February 2023, certified IDR entities were instructed to resume making payment determinations for payment disputes involving items or services furnished before October 25, 2022, as the relevant departments considered how to address a recent court decision involving the surprise billing regulations. Stakeholders noted concern with the potential pause, as IDR entities are facing a significant backlog of disputes.
The standards governing a certified IDR entity’s consideration of information when making payment determinations in these disputes are provided in the August 2022 Requirements Related to Surprise Billing final rules, as revised by the recent US District Court for the Eastern District of Texas order and opinion. Guidance for certified IDR entities’ payment determinations for items and services furnished on or after October 25, 2022, can be found here, and guidance to disputing parties regarding disputes involving items and services furnished on or after October 25, 2022, can be found here.
- The House Ways and Means Health Subcommittee held a hearing on healthcare affordability. The hearing was political in nature, with Republicans convening a panel of witnesses to discuss how inflation and high healthcare costs have impacted patients and small businesses.
- The Senate Committee on Health, Education, Labor and Pensions held a hearing featuring testimony from the CEO of Moderna titled “Taxpayers Paid Billions For It: So Why Would Moderna Consider Quadrupling the Price of the COVID Vaccine?” Prior to the hearing, Moderna announced a new patient assistance program to provide free vaccines to uninsured Americans. Chair Bernie Sanders (I-VT) was critical of Moderna’s profits and proposed price increases, particularly in light of the role that the US government played in funding and contributing to scientific development of the COVID-19 vaccines, while other committee members cautioned that action to restrict profits could disincentivize companies from forming public-private partnerships to develop cures in future crises.
- House Appropriations Ranking Member Rosa DeLauro (D-CT) released a series of letters from federal agencies, focusing on how cutting FY 2024 back to FY 2022 levels, as reportedly being proposed by House Republicans, would require cuts to a number of programs, ranging from Head Start to the 9-8-8 lifeline to community health centers.
- The Health Resources and Services Administration announced an organ transplant modernization initiative that includes actions to strengthen accountability and transparency in the Organ Procurement and Transplantation Network.
- CMS released a blog post on the need to push for continued improvements in patient safety. The post focuses on the levers CMS is using, including expanded and improved measures of safety performance, increased transparency and strong payment incentives to promote improved safety outcomes. We expect additional guidance on these issues in the coming payment rules.
- HHS announced a new office, the Office of Family Violence Prevention and Services (OFVPS), under the Administration for Children and Families (ACF). ACF identified preventing and addressing domestic violence as a key priority. According to HHS, creating a new, separate office and establishing it in the Assistant Secretary’s Office will better position OFVPS to support a comprehensive approach to domestic violence prevention across ACF, HHS and the federal government as a whole.
- HHS, through Substance Abuse and Mental Health Services Administration, announced two funding opportunities for Certified Community Behavioral Health Clinic (CCBHC) expansion, totaling $123.6 million. The CCBHC Planning, Development, and Implementation grant will assist clinics to establish and implement new CCBHC programs, and the CCBHC Improvement and Advancement grant will enhance and support existing CCBHCs that currently meet the certification criteria.
- The Biden Administration marked the 13th anniversary of the Affordable Care Act by highlighting record-breaking enrollment numbers during the 2023 open enrollment period and lower healthcare costs under the American Rescue Plan and Inflation Reduction Act.
NEXT WEEK’S DIAGNOSIS
Budget hearings continue in the House and Senate. The House Energy and Commerce Health Subcommittee will hold a closely watched hearing on examining transparency and competition in healthcare.
For more information, contact Debra Curtis, Kristen O’Brien or Erica Stocker.
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