This Week’s Dose
The House and Senate were both in session this week, and behind-the-scenes work continued on a stopgap funding bill, known as a continuing resolution (CR), that Congress needs to approve before the current fiscal year ends on September 30. Congress began phase III of its reopening plan in the wake of the COVID-19 pandemic, bringing relaxed entry requirements, tour resumptions and additional glimmers of pre-pandemic normalcy back to Capitol Hill. The president released an executive order (EO) on advancing biotechnology, reported on the progress of his cancer moonshot initiative and appointed the first director of the new Advanced Research Projects Agency for Health (ARPA-H).
CR Negotiations Continue as September 30 Fast Approaches. Congress now has just two weeks to avert a government shutdown. Lawmakers continue to seek an agreement on a stop-gap CR to keep programs funded when the new fiscal year begins on October 1, in the absence of the completion of traditional FY 2023 appropriations bills.
Democrats and Republicans are reportedly in agreement on the duration of the CR through December 16, to provide Congress with additional time in the post-election lame duck session to reach a long-term appropriations agreement for the remainder of FY 2023. Partisan differences remain on potential funding and policy add-ons, however.
A key point of contention is whether Democrats can attach an energy permitting reform provision that Senate Majority Leader Schumer (D-NY) promised to Senator Manchin (D-WV) as a condition for his support for the Inflation Reduction Act. The provision—the text of which has not been released yet—has met with resistance from Republicans as well as progressive Democrats.
Democrats and Republicans also have not agreed on whether, and to what extent, to include President Biden’s recent $47.1 billion supplemental funding request, which included $22.4 billion in additional COVID-19 funding, $4.5 billion for monkeypox, and additional funding in response to the ongoing war in Ukraine and recent natural disasters.
It appears the Senate will move first on the CR, given that bipartisan cooperation is necessary to secure the 60 votes required for passage in the 50-50 Senate. House Speaker Pelosi (D-CA) will have to keep most of the progressive wing of her caucus in line in order to advance a Senate-passed CR in advance of the September 30 deadline.
House Passes MA Prior Authorization Legislation While Committee Considers Other Healthcare Bills. On September 14, the House Energy and Commerce Health Subcommittee met to consider five pieces of legislation.
The subcommittee advanced the following bills:
- The Improving Seniors’ Timely Access to Care Act of 2021 (H.R. 3173) – to establish requirements related to the prior authorization process under the Medicare Advantage (MA) program
- The Vaccine Injury Compensation Modernization Act of 2021 (H.R. 3655) – to amend and update the Vaccine Injury Compensation Program
- The Maximizing Outcomes through Better Investments in Lifesaving Equipment for (MOBILE) Health Care Act (H.R. 5141) – to allow federally qualified health centers to use new access point grants for establishing mobile health units, building renovations, and acquisition and construction costs
- The Improving Trauma Systems and Emergency Care Act (H.R. 8163) – to reauthorize and expand trauma care grant programs, and to require guidance to coordinate and improve emergency medical services and trauma care during declared emergencies
- The Flint Registry Reauthorization Act (H.R. 6737) – to reauthorize the lead exposure registry program at $5 million annually for FY 2023 through FY 2033.
The MA prior authorization bill, which the House Ways and Means Committee considered over the summer, was brought to the House floor on September 14, where it passed by voice vote. The legislation had a strong backing from many healthcare provider groups that have voiced concerns about the cost, administrative burdens and disruptions to patient care as a result of prior authorization practices. While the bill only applies to Medicare Advantage plans, it would help streamline prior authorization requests via an electronic pathway and would require plans to follow transparency requirements. Senate consideration of the bill before the lame duck session is unlikely.
Ways and Means Committee Holds Hearing on the Healthcare System and the Climate Crisis. On September 15, the House Ways and Means Committee held a hearing to discuss preparing the nation’s healthcare infrastructure for the climate crisis. The hearing follows the requests for information (RFIs) that Chairman Neal (D-MA) issued earlier this year to various healthcare organizations seeking input on efforts to address climate-related issues.
Moments before the hearing began, the committee released a five-part report titled “Health Care and the Climate Crisis: Preparing America’s Health Care Infrastructure” that provides a comprehensive analysis of the RFI responses the committee received from health systems, hospitals, dialysis companies, nursing homes, community health centers, trade associations and others.
The five parts of the report focus on the following:
- Part One – An overview, a description of Chairman Neal’s RFI and summary statistics from an analysis of survey respondents
- Part Two – An examination of how the climate crisis and the prevalence of extreme weather events impact healthcare organizations
- Part Three – A description of how healthcare organizations are assessing their environmental impact and working to reduce their carbon footprints
- Part Four – A summary of findings and implications
- Part Five – An appendix containing methodology, limitations and supplemental tables.
A full list of RFI respondents can be found here. The Ways and Means Committee intends to build upon the report through continued work with the Administration and healthcare providers nationwide.
President Biden Announces Updates Related to Cancer Moonshot, Biotechnology and ARPA-H. On September 12, President Biden issued several healthcare-related updates, anchored by a speech marking the 60th anniversary of President Kennedy’s original moonshot speech.
In his address, President Biden discussed the details of another moonshot—the cancer moonshot. This effort, which was originally announced by then-Vice President Biden during the Obama Administration, has been reignited during the Biden Administration.
Earlier this year, the Administration formed a Cancer Cabinet, which is working to advance priority actions related to closing the screening gap, understanding and addressing environmental exposure, decreasing the impact of preventable cancers, advancing cutting-edge research, and supporting patients and caregivers. The president’s speech reported on progress and next steps in these areas.
President Biden also signed an EO on Advancing Biotechnology and Biomanufacturing Innovation for a Sustainable, Safe, and Secure American Bioeconomy. This new initiative intends to accelerate biotechnology innovation and grow the nation’s bioeconomy across multiple sectors, including healthcare. It also seeks to drive advances in biomanufacturing that will substitute fragile supply chains from abroad with strong chains at home, improve food and energy security, drive agricultural innovation while mitigating the impacts of climate change, and help people live longer and healthier lives through advances in medicine. This fact sheet from the White House provides additional details on the EO.
Further, President Biden announced his intention to appoint Dr. Renee Wegrzyn—who joined the president at his speech in Boston—to be the first director of ARPA-H, the newly established agency to drive biomedical innovation.
- The Senate Judiciary Committee held a hearing on the importance of immigrants in the healthcare workforce.
- The Senate Health, Education, Labor and Pensions Committee held a hearing on stopping the spread of monkeypox.
- Reps. Bera (D-CA) and Bucshon (R-IN) introduced legislation (H.R. 8800) to mitigate the Centers for Medicare & Medicaid Services’ (CMS’s) proposed 4.4% physician fee schedule cuts for 2023.
- Eight House Republicans sent a letter to US Department of Health and Human Services (HHS) Secretary Becerra, urging the Secretary to release the 42 Code of Federal Regulations Part 2 proposed rule to modernize substance use disorder privacy regulations as required by the Coronavirus Aid, Relief, and Economic Security Act.
- The Medicaid and CHIP Payment and Access Commission held a two-day public meeting on September 15-16 covering a range of topics, including race and ethnicity data collection, unwinding the continuous coverage requirement, Medicaid managed care rate setting and risk mitigation, and integrating care for dually eligible beneficiaries in Medicaid fee-for-service.
- CMS announced approval of the Oregon Health Authority’s proposal to cover community-based mobile crisis intervention services under Medicaid, which will be the nation’s first Medicaid mobile crisis intervention services program.
- The US Census Bureau released data on health insurance coverage in 2021, showing an increase in the number of people insured compared to the previous year. Gains in coverage stemmed from increased enrollment in government programs.
- HHS Secretary Becerra announced that he formally swore in Melanie Fontes Rainer as director of the Office for Civil Rights.
- HHS, along with the US Departments of Treasury and Labor, issued an RFI seeking feedback to inform rulemaking for the advanced explanation of benefits and good faith estimate requirements of the No Surprises Act. The RFI seeks information and recommendations on transferring data from providers and facilities to plans, issuers and carriers; other policy approaches; and the economic impacts of implementing these requirements.
Next Week’s Diagnosis
The House and Senate will both be in session next week as work continues on a CR to keep government programs funded until after the midterm elections.
For more information, contact Debra Curtis, Kristen O’Brien or Erica Stocker.
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