THIS WEEK’S DOSE
A key takeaway from the November 8 midterm elections is how closely divided the electorate remains. While several races have yet to be called as this update goes to press, it appears likely that Republicans will take control of the House, but by a narrower margin than anticipated. Control of the Senate hinges on the still-uncalled races in Nevada and Arizona, along with Georgia, which is headed for a runoff in early December. The impact of these outcomes—along with key gubernatorial races and ballot initiatives related to abortion rights, Medicaid expansion and medical debt—on health policy heading into 2023 will continue to come into focus in the days and weeks ahead.
Lame Duck Session Set to Begin. Congress will return to session the week of November 14, kicking off a lame duck session with a lengthy to-do list. The week of November 14 will be consumed with internal organizing activities in preparation for the upcoming 118th Congress, which will formally convene in early January. House Republicans have indicated that they will hold leadership elections that week, while House Democrats are likely to hold off on their leadership elections until after Thanksgiving.
Once Congress returns from the Thanksgiving holiday, year-end legislative business is expected to begin in earnest (although behind-the-scenes work has been ongoing over the past weeks). The top “must pass” item on Congress’s to-do list is an omnibus appropriations package that funds the government for the remainder of fiscal year 2023. This package will be the key piece of legislation that moves during this final stretch of calendar year 2022 and, as a result, will become the vehicle for other policy priorities, including healthcare. See our lame duck preview for additional details on healthcare policy priorities.
Decisions are also expected imminently on committee leadership positions and new committee rosters for the 118th Congress. We’ll provide updates on the decisions impacting the key healthcare committees—House Ways and Means; House Energy and Commerce; Senate Finance; and Senate Health, Education, Labor and Pensions—in upcoming editions of the Check-Up.
CMS Innovation Center Releases Report on Strategic Refresh and Hints at New Mandatory Model. On November 7, the Centers for Medicare & Medicaid Services Innovation Center released a report on the implementation of its refreshed strategic vision and objectives.
The one-year report outlines actions taken and includes a roadmap for how the Innovation Center will continue to execute its strategy, including the following:
- Announcing and launching new accountable care models that increase access to advanced, high-quality primary care, with more focus on underserved populations
- Developing strategies to drive better integration of primary and specialty care to serve those with chronic or serious conditions
- Improving the way providers are incentivized, the way care is delivered, and the way information is distributed to individuals and across care settings.
In a related blog post that also highlights concerns about market consolidation in specialty care, the Innovation Center notes a greater focus on integrating specialty care into models via the following strategies:
- Enhancing transparency in clinician performance
- Continuing deployment of episode payment models that align with accountable care organizations and primary care, including mandatory models
- Supporting specialists to further embed in primary-care focused models
- Creating incentives within population-based models to encourage specialty care integration.
Notably, in announcing a two-year extension of the Bundled Payments for Care Improvement Advanced Model, the Innovation Center indicated that it will pursue the development of a mandatory episode payment model in 2023. While some stakeholders have advocated against mandatory models in the past and have challenged many previous Innovation Center efforts to implement broad demonstrations, others support the move to mandatory models as a necessary step to accelerate the transition to value-based care. The Innovation Center will provide more detail on these efforts in a December 1 webinar (click here to register).
- The US Departments of Health and Human Services, Labor and the Treasury jointly announced three new organizations that will serve as independent dispute resolution (IDR) entities in the federal IDR process: EdiPhy Advisors, L.L.C.; Provider Resources, Inc.; and iMPROve Health. The IDR process addresses disagreements related to the new surprise medical billing requirements. The updated certified IDR list can be found here.
- The US Government Accountability Office released a report on private health insurance titled “Markets Remained Concentrated through 2020, with Increases in the Individual and Small Group Markets.”
- More than 40 Members of Congress sent a letter to House leaders, asking that Congress include an extension of the advanced alternative payment model 5% incentive payments in a year-end legislative package.
NEXT WEEK’S DIAGNOSIS
Congress will begin its lame duck session next week. The week’s business will be largely organizational in preparation for the 118th Congress. Following the Thanksgiving holiday, year-end legislative efforts will get underway in earnest.
For more information, contact Debra Curtis, Kristen O’Brien or Erica Stocker.
To subscribe to the McDermottPlus Check-Up, please CLICK HERE.